01/01/2016

Ghagan Bhatnagar is a Clinical Oncologist and Junior Doctor and explains why he feels Junior Doctors would be justified in taking strike action.

Industrial action is not a step that a doctor takes lightly.

I am not unique, nor am I alone. There are 50,000 junior doctors who have made the same sacrifice with a common goal in mind – patient care. It is precisely for this reason that I have voted for industrial action. As counter-intuitive as this may seem to the non-medic – doctors truly are striking for the safety of the public.

Allow me to explain – we are trained, nay, indoctrinated to analyse the risk versus benefit of every action we take as doctor. We use scientific evidence to help guide our decisions – this is aptly known as ‘evidence based medicine’. When I prescribe chemotherapy I have to analyse all the life-threatening side effects that could befall my patient, and weigh it up against the benefit my patient may receive from the toxic drug. I make a similar risk assessment when I prescribe Paracetamol (Do they have liver failure? Are they on other medications?).

In a similar manner doctors up and down the country have weighed up the risk versus benefit of the new junior contract and the possibility of industrial action. Thankfully, we have scrutinised the details of the Department of Health’s offer and have not fallen victim to catchy headlines and government rhetoric. Sadly, the devil truly is in the details.

We are desperate not to strike, because the service will halt and there is a possibility that patients might come to harm (though we will do everything in our power to ensure necessary safeguards are in place). Having analysed the contract with the same keen eye with which we analyse our patients, many doctors are reluctantly voting for industrial action because the alternative is far worse.

Doctors envisage a future where we are overworked due to lack of penalties on Trusts for overworking us (the Health Secretary has still offered no safeguards for this). We envisage a future where women, who make up a majority of junior doctors, cannot balance family life and career and have to choose between the two. We envisage a future where doctors are penalised for pursuing research for ground-breaking new therapies for cancer or dementia. We envisage a future where a doctor’s experience is not valued and rewarded. We envisage a future where the work-life balance of vital specialties such as Accident & Emergency is untenable and will suffer crippling losses to the work-force (which is already under-recruited). We envisage a future where children simply don’t want to be doctors because the gruelling training is not valued by the government. Some envisage a future of private health-care being pushed through by the government where patients may be asked to choose between cancer treatment and selling their homes.

This future would be a grim place to be a patient. Unfortunately, the risk versus benefit ratio is heavily in favour of a short term inconvenience to avoid a long-term catastrophe.

The Health Secretary, whatever his intentions, has little understanding of the front line and what doctors and nurses sacrifice to make the NHS work under increasing financial strain. For a decade we have continually been doing more with less, and the service is spread dangerously thin as it is. His words ring empty when he commends us for being the back-bone of the NHS but in the same breath tells us to ‘get real’. Or when he suggests doctors are not willing to negotiate when of the 23 key points he has stated 22 are non-negotiable (the single point he is willing to negotiate is travel expenses).

His lack of understanding has been shown clearly with his repeated misuse of scientific data for which he was reprimanded by Fiona Godlee, the chief editor of the British Medical Journal. His promises of 11% payroll rises (while apparently remaining cost neutral) fall to pieces when the details are examined. Unfortunately Mr Hunt is playing a game of politics while the entire medical profession is whistleblowing at a contract that is unsafe for patients and may be the demise of the NHS.

Like any other person, or any other profession, we want to feel valued. Reducing our pay (in real terms) by up to 25% is just one of the issues at stake (Mr Hunt has offered a ‘temporary pay protection’ but future junior doctors will be worse off). We are not asking for a pay rise. We are asking to be valued. We are asking for the right to a social and family life. We are asking to be treated as a bright and dedicated workforce that can think for ourselves. Give us autonomy. I am dismayed the Secretary of Health has not once asked for the advice or guidance from the doctors he is supposedly working with. Why not ask us how to improve service? Surely we have more insight than anyone else?

A doctor that is happy and feels valued will go much further for their patients – because that is the only thing we know. We channel our lives to be single minded – patient safety is our calling.

If patient safety was truly the Health Secretary’s aim, he would heed our calls.

Drop the pre-conditions. Drop your threat of imposition. Adequately fund and staff your plans or appreciate what is actually feasible. Listen to our concerns and get us back round the table.

The strike is avoidable, and it is at Mr Hunt’s discretion.

Dr Gagan Bhatnagar

COMING SOON.... latest developements and more information on contracts in the second issue of RUMS Review, due out in January.